Cryptococcus in bagpipes: The great debate

The most famous debate about cryptococcus in bagpipes occurred in 1978 in (some of) the pages of the medical journal The Lancet. The debate began with this report from Australia:

CRYPTOCOCCUS IN BAGPIPES,” R. Cobcroft, H. Kronenberg, T. Wilkinson,The Lancet, Volume 311, Issue 8078, 24 June 1978, Pages 1368-1369. The authors, at the Royal Prince Albert Hopsital, Sydney, Australia, write:

In February, 1978, while the patient was still in complete remission [from lukaemia], a chest X-ray, done because of a persistent cough, revealed bilateral basal round opacities 5-10 cm in diameter.

Sputum culture grew Cryptococcus neoformans and this was also cultured from the bag of his bagpipes…. The bagpipes’ ancient design differs from that of other musical instruments… [it] acts as a very good fungal culture medium. Fungal spores in the air of the bag reach the player’s mouth because of some back-flow through the mouthpiece valve which occurs at the time of maximum inspiration, probably carrying the spores into the lungs in much the same way as sodium cromoglycate inhaler deposits particles into the bronchial tree.

Whether the patient was infected from the bagpipes or the bagpipes were secondarily infected, can never be known, but since fungal infection of the lungs is a severe life-threatening condition, particularly in immunosuppressed patients, bagpipe playing should be avoided in such patients.

The debate continued, a few weeks later, with this observation from England:

CRYPTOCOCCUS IN BAGPIPES,” David Stevenson, The Lancet, Volume 312, Issue 8080, 8 July 1978, Pages 104-105. The author, at the Liverpool School of Tropical Medicine, writes:

Dr Cobcroft and others may be overdogmatic in their warning of the dangers of playing the bagpipe. That fungal spores in the bag reach the player’s mouth by back-flow through the mouthpiece valve is a supposition for which they offer no evidence. In any case, valves vary greatly in efficiency. Some pipers use the tip of their tongue instead of a valve, which may virtually eliminate back-flow. Pipers may be classified into “wet” and “dry” blowers….

BONUS: This video shows part of a documentary about how bagpipes are made: